Photo Rounds

Hip pain prohibits walking

A 60-year-old woman was brought in to see her family physician (FP) in a wheelchair after falling earlier that day. During the fall, the patient felt a pop in her hip, accompanied by immediate pain that prohibited her from walking. The FP noted an externally rotated and abducted left hip on physical exam. The hip region was also tender, swollen, and had local ecchymosis. The FP ordered an x-ray.

What's your diagnosis?


This patient had a transcervical left femoral neck fracture. The radiologist noted that there was varus angulation and superior offset of the distal fracture fragment. The FP called the orthopedic surgeon, who admitted the patient to the hospital for deep vein thrombosis prophylaxis and preparation for surgery. After months of rehabilitation, the patient was able to walk again. A dual-energy x-ray absorptiometry (DEXA) scan showed osteoporosis, and treatment was initiated.

Approximately 300,000 hip fractures occur every year in the United States, and 70% to 80% of them are in women. The average age at fracture is 70 to 80 years, but the risk increases with age. Half of patients with a hip fracture have osteoporosis. Other risk factors include: postural instability and/or quadriceps weakness, history of falls, prior hip fracture, dementia, tobacco use, physical inactivity, impaired vision, and alcohol use.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley, H. Hip fracture. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:615-618.

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